Psychological distress and its impact on wound healing: an integrative review

Wound healing is typically divided into 4 stages; disruption of any one of these stages can impair this process. This integrative review summarizes findings from key studies suggesting that psychological distress may exert a clinically relevant impact on wound healing. For example, stress has been shown to decrease levels of inflammatory mediators, prolonging the inflammatory stage of healing, and increasing overall healing time. Depression has also been linked with impeding wound healing. Hostility has also been correlated with decreased inflammatory mediators, conversely, effective communication has shown faster healing time. Compounding factors such as unhealthy behaviors are also linked to poor wound healing, such as decreased sleep, poor nutrition, reduced exercise, and increased alcohol use. Clinical evidence suggests that alcohol exposure can reduce angiogenesis. Limited sleep decreases growth hormone secretion, resulting in decreased monocyte migration and activation of macrophages. protein deficiency can decrease capillary formation, collagen synthesis, and wound remodeling. Such evidence challenges clinicians to consider psychological factors when treating wound care patients.